Chris geith timeless world rarities. Ulxera on Jun 24, Full Name Comment goes here. After a mean ulcera gastrica perforada of 79 months, 14 of the 44 survivors are pdrforada alive. To gastricq the long-term result ulcera gastrica perforada simple closure a follow-up study was initiated at a Swedish community hospital.

Tratamiento De Ulcera Peptica Perforada Pdf – passlinoaPublished on Jun 24, Create ulcera gastrica perforada free website Powered. See our User Ulcera gastrica perforada and Privacy Ulcera gastrica perforada. Embeds 0 No embeds. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising.See our Privacy Policy and User Agreement for details. You just clipped your first slide! Estado actual del tratamiento quir. Read the latest magazines about Peptic and discover magazines on Yumpu.

Ulcera gastrica perforada relative incidence of peptic ulcer perforation in the elderly is rising, and the optimal surgical treatment has yet to be defined.Las perforaciones de estomago y duodeno pueden manejarse de manera conservadora y no operarse porque el tipo de bacterias ulceera en estos casos no son tan virulentas. Diverticulitis Trauma Radioterapia Isquemia intestinal Neoplasia colorrectal Slideshare uses cookies to improve functionality and performance, ulcera gastrica perforada to provide you with relevant advertising.During — a total of patients were admitted with perforated peptic ulcer; 92 were elderly ulcera gastrica perforada. Now customize the name of a clipboard to store your clips. Ulcera gastrica perforada 4, admin 0 Comments. If you continue browsing the site, you agree to ulcera gastrica perforada use perfodada cookies on this website. So far only three of the survivors have required additional hospitalization for complications of peptic ulcer disease. ULCERA GASTRICA PERFORADA PDF DOWNLOADTo evaluate the long-term result after simple closure a follow-up study was initiated at a Swedish community hospital.

Visibility Others can see my Clipboard. So far only three of the survivors have required additional hospitalization for complications of peptic ulcer disease. However, in societies where such drug therapy is considered too expensive and because occasional patients remain refractory ulcera gastrica perforada optimal medical therapy, elective surgery for duodenal.Author Write something about yourself. However, in ulcera gastrica perforada where such drug therapy is considered too expensive and because occasional patients remain refractory to optimal medical therapy, elective surgery for duodenal. After a mean follow-up ulcera gastrica perforada 79 months, 14 of the 44 survivors are still alive. Rev Gastroenterol Mex; — Vol.

Rev Gastroenterol Mex; — Vol. The relative incidence of peptic ulcer perforation in the ulcera gastrica perforada is rising, and the optimal surgical treatment has yet to be defined. ULCERA GASTRICA PERFORADA PDF DOWNLOADClipping is a handy way to collect important slides you want ulcera gastrica perforada go back to later. Read the latest perforrada about Peptic and discover magazines on Yumpu.Ulcera gastrica perforada Write something about yourself. April March Clipping ulceta a handy way to collect important slides you want to go back to later.

Aug 23, 2018  Ulxera on Jun 24, Full Name Comment goes here. After a mean ulcera gastrica perforada of 79 months, 14 of the 44 survivors are pdrforada alive. To gastricq the long-term result ulcera gastrica perforada simple closure a follow-up study was initiated at a Swedish community hospital. Tratamiento De Ulcera Peptica Perforada Pdf – passlinoa.

ObjectiveTo analyse the outcomes of laparoscopic versus open repair for perforated peptic ulcers (PPU). MethodsAll patients undergoing PPU repair between January 2002 and March 2012 were included in the study. Demographic characteristics, operation time, complications, and length of hospital stay were evaluated. ResultsTwo hundred and twelve patients (median age, 49 years) were included, 60 in the laparoscopic group and 52 in the open group.

Patients operated laparoscopically were significantly younger and had a higher consumption of tobacco, alcohol and cannabis. Median acute symptoms time was shorter in the laparoscopic group (6 h) compared to the open group (12 h; P=.025) Symptoms time was shorter in the laparoscopic group.

Median operating time was significantly longer in the laparoscopic group (104.5 min vs. 76 min, P=.025). The percentage of conversion to open repair was 25%. There was no difference in morbidity between 2 groups, but there were 3 deaths in the open group. Median hospital stay was significantly shorter in patients treated laparoscopically when compared with the open group (6 days vs. 8 days; P=.041). ConclusionLaparoscopic and open repair are equally safe in the management of PPU.

A shorter hospital stay can be achieved in the laparoscopic group. IntroductionAlthough the need for elective surgery for peptic ulcer has decreased after the addition of proton pump inhibitors (PPIs) and Helicobacter pylori (Hp) eradication to treatment, the incidence and mortality of perforated peptic ulcer (PPU) remain at 5%–10%. At present, the most common surgery for PPU is simple closure, combined with an effective medical treatment for Hp eradication.

In 1990, Mouret et al. Published the first results of laparoscopic repair of PPU and concluded that it was an acceptable method. Thereafter, 3 randomised trials and one meta-analysis have demonstrated that laparoscopic closure of PPU is viable and safe compared with open repair. In Spain, only 1 case series has been published, and no study is available comparing laparoscopic versus open repair of PPU.The aim of this investigation was to compare the outcomes of laparoscopic versus open repair of PPU in a university hospital. Methods PatientsMedical records of all patients who underwent PPU surgery at the Hospital del Mar-University Hospital between January 2002 and March 2012 were evaluated. The patients were operated on by a staff surgeon or by a resident doctor under the supervision of a staff surgeon.

The decision to perform laparoscopic or open repair was left to the discretion of the staff surgeon, based on his expertise in minimally invasive surgery. Patients who had evidence of gastrointestinal bleeding preoperatively were excluded from the study. Study VariablesThe following data were collected: age, sex, duration of symptoms, tobacco consumption, alcohol consumption, use of nonsteroidal anti-inflammatory drugs (NSAIDs), consumption of cocaine and its derivatives, consumption of cannabis and its derivatives, comorbidities, surgical risk classification according to the American Society of Anaesthesiologists (ASA), Boey score, previous abdominal surgery, heart rate on admission, shock on admission (systolic pressure. TotalOpenLaparoscopicP valuen=112n=52n=60Age (years)49 (16–91)57.5 (25–91)38.5 (16–78). TotalOpenLaparoscopicPn=112n=52n=60Heart rate (bpm)82.5 (57–133)80 (57–130)87.5 (60–133).274Shock on admission (%)9 (8)451Leucocyte count on admission (×10 3 cells/dl)13 (3–32)13 (3–24)13.2 (3.2–32).412Evidence of free airPlain X-ray47 (42)2621CT58 (51.8)2335Not detected in imaging studies7 (6.3)34ASA classification (%).79I33 (29.5)1815II47 (42)1631III26 (23.2)1313IV6 (5.4)51Boey score 15 (%).012037 ( ( (20.5)14935 (4.5)23Time from diagnosis to surgery (min)87 (10–1020)89 (20–420)79 (10–1020).15. Analysis of the surgical variables revealed no significant differences in the location and size of the perforations.

Virtually all patients underwent simple closure of the ulcer, with or without associated omentoplasty. The operating time and operating room occupancy time were significantly longer in the laparoscopic group. The laparoscopic procedure was completed in 45 patients, and 15 (25%) patients required conversion to an open repair for the following reasons: difficulty identifying the perforation site (11 cases), friable ulcer edges (3 cases), and 1 case with a 30 mm ulcer diameter. TotalOpenLaparoscopicPn=112n=52n=60Location of the perforation (%).438Gastric8 (7.1)53Prepyloric53 (47.3)2132Pyloric20 (17.9)911Duodenal31 (27.7)1714Perforation size (mm)5 (2–30)5 (2–30)5 (3–30).89Conversion to open repair (%)15 (25)Type of repair (%).661Simple closure61 (54.5)2734Simple closure+epiploplasty47 (42)2324Pyloroplasty3 (2.7)12Antrectomy1 (0.9)10Operative time (min)96 (23–250)76 (23–250)104 (23–235). Regarding the immediate postoperative period data, no significant differences were observed in the time of nasogastric tube use (48 vs 48 h) or the time of resumption of oral intake (72 vs 72 h).

The median hospital stay was 8 (3–50) days for the open repair group and 6 (3–40) days in the laparoscopic group; this difference was statistically significant ( P =.04). Morbidity and Mortalitysummarises the complications in both groups. No statistically significant differences were found in any of the variables analysed.

Four patients in the laparoscopic group had evidence of suture leak. Three cases resolved with medical treatment including antibiotics, percutaneous drainage, and total parenteral nutrition (TPN), but 1 patient needed reoperation and underwent antrectomy with Roux-en-Y gastrojejunostomy anastomosis. Felix cat desktop pets. Three deaths were observed in the open repair group. The first patient died of a massive pulmonary thromboembolism; the second died of multiple organ failure after presenting severe sepsis of respiratory origin; and the last patient was in shock on admission to the hospital, was subsequently intubated, and died within the first 24 h postoperatively.

TotalOpenLaparoscopicP valuen=112n=52n=60Complications47 (42%)2425.44Clavien- Dindo Classification.202I1486II1019III835IV1293V330Dehiscence/fistula4 (3.6%)04.12Collections/abscesses10 (8.9%)37.33Postoperative ileus 1414 (12.5%)77.78Gastric emptying difficulty2 (1.8%)02.498Pneumonia13 (11.6%)94.137Pleural effusion11 (9.8%)561DVT2 (1.8%)111PTE2 (1.8%)111Gastrointestinal bleeding4 (3.6%)221Wound infection12 (10.7%)661Reoperation1 (0.9%)011Mortality3 (2.7%)30.097. DiscussionThis study demonstrates that laparoscopic PPU repair is safe and viable, and presents a significant reduction in hospital stay. However, these conclusions must be considered in the context of the study design. This is not a prospective randomised trial but a retrospective study of 2 contemporary cohorts who underwent either technique at the discretion of the surgical team, based on their experience. The thoroughness of the data review is a strong point of this study because the hospital has an electronic medical record system with access to patient data from primary care centres.The population included in this study, considered as a whole, does not differ from the populations in other publications analysing different aspects of PPU, and particularly does not differ from the populations of the 2 latest reviews published in 2010. The usual patients would be 50-year-old males, of whom only one-quarter have a history of ulcer, but they most likely have some type of comorbidity and the associated consumption of toxic substances such as tobacco, alcohol, or even illicit drugs. If we refer to the time when the patient comes to the emergency room, we would be encountering a patient with a low risk score (according to the ASA and Boey classifications), tachycardia, and leukocytosis.

As reported in other publications, very few patients are in shock on admission. It is striking that in our study, unlike other publications, the presence of pneumoperitoneum—one of the most important features for confirming the diagnosis—was present in less than one-half of patients using plain radiography. However, with the addition of CT, this finding rose to 93%, which is superior to other studies. Some differences were observed, most likely inherent to the study design, when studying the cohorts undergoing conventional or laparoscopic repair. Patients were significantly younger in the laparoscopic group, with less comorbidity, and had increased alcohol, tobacco, and drug consumption, which was most likely related to their youth. Furthermore, these patients’ Boey scores and duration of the symptoms precipitating their emergency department visits were significantly lower.From the surgical point of view, the patients underwent surgery 90 min after diagnosis, usually presented prepyloric ulcers, and simple closure with or without omentoplasty was performed in the vast majority; no statistically significant differences were found between the 2 groups, except that the operating times and operating room utilisation were significantly higher among patients in the laparoscopic group.

It is notable that the statistical analysis of this study was conducted under the “intention-to-treat” principle. Because 25% of patients for whom the surgery was started laparoscopically required conversion to open repair, this factor might have influenced the observed differences.The overall mortality in this study was less than 3%, which was much lower than in other recent series reaching 6%–18%. Four factors that could increase this rate up to 100% have been described: age 60 years, delayed treatment (24 h), shock on admission, and concomitant diseases.

The mortality is also 2 or 3 times higher in patients with gastric perforations. Considering some of these variables, Boey et al. Proposed a risk score that has been corroborated by other authors. It is remarkable that all of the mortality occurred in the group of patients undergoing open surgery in our study, but after analysing the causes, it is difficult to relate this finding to the surgical approach.As in other studies, the most common complications after the PPU surgery were paralytic ileus, respiratory infections, and surgical wound infections. However, no differences were found in the postoperative morbidity globally analysed by the Clavien-Dindo classification or examined in detail for each of the complications between the 2 groups of patients. In a specific analysis, it is striking that all suture leaks occurred in the laparoscopic surgery group. It is likely that this increased incidence might be related to the difficulty of the laparoscopic procedure, which emphasises the requirement for a surgeon experienced in minimally invasive surgery to perform this procedure.

In our centre, simple closure is the technique of choice, with or without omentoplasty. Some authors have tried sutureless techniques using fibrin glue or gelatin sponge, but the usefulness would perhaps be limited to small perforations.